Assessment of Cerebral Vasodilatory Capacity as Part of Catheter‐Based Cerebral Angiography

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Abstract
BACKGROUND AND PURPOSE: Cerebral vasodilatory capacity assessment for risk stratification in patients with extracranial arterial stenosis or occlusion may be useful. We describe a new method that assesses cerebral vasodilatory capacity as part of catheter‐based cerebral angiography.METHODS: We prospectively assessed regional cerebral blood volume (rCBV) in the arterial distribution of interest using a controlled contrast injection in the common carotid or the subclavian arteries. rCBV maps were created using a predefined algorithm based on contrast distribution in the venous phase (voxel size: .466 mm3). rCBV maps were acquired again after selective administration of intra‐arterial nicardipine (2.0 mg) distal to the stenosis. Two independent observers graded the change in rCBV in 10 predefined anatomical regions within the tributaries of the artery of interest (0 = reduction, 1 = no change, 2 = increase) and total rCBV change scores were summated.RESULTS: Twenty‐five patients with internal carotid artery stenosis (n = 18; 0‐90% in severity) or extracranial vertebral artery stenosis (n = 7; 0‐100% in severity) were assessed. There was an increase in rCBV in a tributary of the artery of interest in 18 of 25 after intra‐arterial nicardipine (mean score: 11.98; range 0‐19.5). There was no change or decrease in rCBV in 7 of 25 patients. The mean rCBV change score was similar in patients with an assessment of internal carotid artery or vertebral artery distributions (12.2 ± 5.3; 11.4 ± 2.5; P = .68).CONCLUSION: Selective vasodilatory response to intra‐arterial nicardipine in the affected arterial distribution during catheter‐based cerebral angiography may provide new data for risk stratification.

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